CO Initial App June2011

8/6/2019 CO Initial App June2011

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Application Packet for a Colorado CPA Certificatefor Initial Applicants



APPLICATION CHECKLIST

FORM A - Application FormE-Mail address providedExplanation of "yes" answers of questions 6-18 (if applicable)

FORM B - Affidavit of Eligibility

FORM C - Certificate of Experience

FORM D - Verifier's Licensure Verification Form (Only if verifier is licensed outside of Colorado)

FORM E - Authorization for Interstate Exchange (Transfer of Grades applicants ONLY)

EDUCATION - Transcript(s) or Foreign Evaluation(s)

AICPA ETHICS EXAM CERTIFICATE OF COMPLETION WITH SCORE.

RESUME

BUSINESS CARD AND LETTERHEAD (Disregard if you do not have access to this information)

U.S. SOCIAL SECURITY NUMBER AFFIDAVIT FORM (Only if you do not have a U.S. SS# and arenot physically present in the U.S.) Form is located on www.nasbatools.com.

Notice for Foreign Applicants Regarding a Social Security Number All applicants who reside in the United States must provide their social security number when applying for licensure. TheDivision will accept a sworn SSN Affidavit in lieu of a social security number from foreign nationals not physically in the U.S.

FEE - Certified check, money order or credit card made payable to NASBA Licensing Services.Exam Fee = $110 Transfer of Grades Fee = $185 (Credit card form included in application)

** ALL FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE**

P.O. Box 198589Nashville, TN 37219

Toll Free : 866.350.0017615.880.4200

www.nasbatools.com

Mail application to:

Revised 11/

Please see our website www.nasbatools.com for additional instructions and forms.



* Complete form in its entirety.

* If you answer "yes" to any of the questions 6-18, provide an explanation on a separate sheet of paper.

Misdemeanor/Felony Questions: Please give detailedexplanations including date and type of offense andthe details of the resolution. Include any documentation pertaining to the offense.

* Complete the form in its entirety.

* Forward to the board from which the CPA exam was passed.

* Upon receipt, include with application packet.

* Complete the first two boxes.

* Forward the form to the verifying CPA'slicensing board, if outside of Colorado.

* Upon receipt, include with application packet.

* If verifier is a Chartered Accountant with a permitto practice, please include a letter of good standingfrom the CA Institute approved by the InternationalQualifications Appraisal Board. (IQAB)

Revised 11/2010

* Any dates given within the application must be in

the mm/dd/yyyy format.

* Make sure to provide an e-mail address, for e-mailis the main source of correspondence. Your Online

Application Status Inquiry System(OASIS) ID and password will be forwarded to you throughe-mail.

* If you are applying under Rule 2.7 Education inLieu of Work Experience, please omit Forms Cand D.

* See "Helpful Hints for Completing the Affidavitof Eligibility", located on the Colorado StateBoard's website. (Link is located on our websiteNASBAtools.com)

* Complete the first page in its entirety. Make sure

all boxes are checked appropriately.

* Provide detailed company job description.

* Each additional page with job description must besigned by the verifier.

* Forward the form to the verifying CPA forcompletion of form.

* Upon receipt of form, include with the application packet.

GENERAL DIRECTIONS FORM A - Application Form

FORM B - Affidavit of Eligibility FORM C - Certificate of Experience

FORM D - Verifier's Licensure Verification FORM E - Authorization for Interstate Exchange

Instructions




COLORADO Application for CPA Certificate

Initial Applicant

First Name Middle Name Last Name Maiden/Other

Date of Birth (mm/dd/yyyy) U.S. Social Security Number

Both addresses are required to be listed. Please check preferred mailing address.

Residence Address:

Business Address:

Street

City State Zip Code Telephone

Employer

Street

CityState Zip Code Telephone

Fax Number

E-Mail

Revised 11/2010

FORM

Preferred

Preferred

1. Are you a resident of Colorado?

2. When did you become a resident of Colorado? to

3. Have you been employed in Colorado?If yes, provide dates. to

4. I have attached details of my work history while residing in Colorado providing details of allaccounting related duties.

5. Did you pass the Uniform CPA Exam? (If more than 10 years ago, please see Form F) List Jurisdiction

6. Do you hold an active CPA license to practice?List Jurisdiction(s): Expiration Date:

7. Have you worked as a CPA or held out since residing in Colorado?I have attached an explanation for performing work as a CPA and/or using the CPA designation prior to licensure. Yes or No (circle one)

8. Have you used any other title, designation, words, letters, abbreviation, sign, card, or device in Coloradotending to indicate that you are a certified public accountant?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Screening Questions

** All final decisions regarding applications are made by the Colorado State Board of Accountancy.**



9. Have you provided public accounting services in the public for a fee in Colorado as a Coloradocertified public accountant?

10. Have you performed audits or attestation services while residing in Colorado?

11. Have you acted as a partner, shareholder, or member of a registered partnership, professionalcorporation, or limited liability company composed of certified public accountants in Colorado?

If yes, cite the name and address of the entity: 12. Have you issued, authored, or published any opinion or certificate relating to any accounting or

financial statement using the title or designation "certified public accountant" or the abbreviation"CPA" in Colorado?

13. Have you attested to or expressed an opinion, as an independent auditor, as to the financial position,changes in financial position, or financial results of the operation of any person, organization, or corporation,or as to the accuracy or reliability of any financial information contained in any such accounting or financialstatement in Colorado?

14. Have you supervised the work of any person who is attempting to gain experience for a Colorado CPA certificate?

If yes, cite the full name of the person; 15. Have you ever had a professional or vocational license suspended or revoked by this or any state or

foreign country?

16. Have you ever had the right to practice before any state or federal agency suspended or revoked forimproper conduct or willful violation of the rules or regulations of the rules or regulations of such stateor federal agency?

17. Have you ever been convicted of a felony under the laws of any state or of the United States?If yes, please provide an explanation on a separate sheet of paper.

18. Have you entered a plea of guilty or plea of nolo contendere accepted by the court?If yes, please provide an explanation on a separate sheet of paper.

19. Do you now abuse or excessively use, or have you in the last five years abused or excessively used, anyhabit forming drug, including alcohol,or any controlled substance that has a) resulted in any accusation ordiscipline for misconduct, unreliability, neglect of work, or failure to meet professional responsibilities; orb) affected your ability to practice as a CPA safely and competently?

20. Have you completed the required AICPA Ethics Course?

21. I will complete a two hour Colorado Rules and Regulation Course within six months of licensure.

22. Have you read and fully understand the Colorado Accountancy Laws and the Board's Rules?

23. Do you agree to appear in person, if requested, at a time and place fixed by the board or furnishadditional information requested of you for the purpose of aiding the board in determining qualifications?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Section 24-34-107(1) of the Colorado Revised Statutes requires that every application by an individual for a license issued pursuant to the authorityset forth in title 12, C.R.S., by the Department of Regulatory Agencies, shall require the applicant's social security number. Disclosure of yoursocial security number is mandatory for purposes of establishing, modifying, or enforcing child support under § 14-14-113 and §26-13-126, C.R.S.;and locating an individual who is under an obligation to pay child support as required by § 26-13-107(3)(a)(I)(A), C.R.S. Failure to provide yoursocial security number for these mandatory purposes will result in an incomplete application. Disclosure of your social security number is

voluntary for disclosure to other state regulatory agencies, testing and examination vendors, law enforcement agencies, and other privatefederations and associations involved in professional regulation for identification purposes only. Your social security number will not be releasedfor any other purpose not provided for by law.

In accordance with sections 18-8-503 and 18-8-501(2)(a)(I), C.R.S., false statements made herein are punishable by law. I state, under penalty of perjury in the second degree, as defined in 18-8-503, C.R.S., that the information contained in this application, to the best of my knowledge, istrue and correct. I understand that under the Colorado Accountancy Law, providing false information to the Board is grounds for denial,suspension, or revocation of a CPA certificate. I further state that I have read all disclosures contained in the application packet including the onerelated to social security numbers.

Signature of Applicant Date

Revised 11/



FORM B

Affidavit of Eligibility Page 1 of 2 Revised 5/2011

Colorado Department of Regulatory AgenciesDivision of Registrations

1560 Broadway, Suite 1350Denver, CO 80202

Licensee/Applicant Full Legal Name

Last First

Colorado Professional or Occupational License/Certification/Registration Number:(if already licensed)

Professional or Occupational License/Certification/Registration type applying for: _________________________

AFFIDAVIT OF ELIGIBILITY

Pursuant to H.B. 06S-1009, C.R.S. 24-34-107, ALL applicants for original licensure* or licensees renewing or reinstating acurrent Colorado license after January 1, 2007 are required to complete and sign this Affidavit of Eligibility.

*The word "licensure" is used as a general term. While most of the professions and occupations are licensed, others may be certified, registered, or listed. For precise terminology and requirements related to a profession or occupation, please consult the website of the appropriate board or program.

Section A: LAWFUL PRESENCE in the United States

1. I am a U.S. citizen. Check one of the acceptable secure and verifiable documents in Section B that applies andfully complete the information requested. Complete documentation must be provided upon request.

2. I am not a U.S. citizen, but I am lawfully present in the U.S. and authorized by the Department of Homeland Securityto be employed in the U.S. Check one of the acceptable secure and verifiable documents in Section B thatapplies and fully complete the information requested. Complete documentation must be provided upon request.

3. I am not physically present in the U.S. under 8 U.S.C. sec. 1621 (c)(2)(c) or employed in the U.S. pursuant to 8 U.S.C.sec. 1621 (c)(2)(a). Check one option, a or b below, then skip to Section C. (Do not complete Section B.)

a. I am a U.S. citizen, not physically present or employed in the United States.b. I am a Foreign National, not physically present or employed in the United States.

Section B: SECURE AND VERIFIABLE DOCUMENTSSelect ONE document in this section if you checked 1 or 2 in Section A.

Government IssuedIdentification

Name of state agencyor federal agency thatissued the document

Full name as shown on driver’slicense or state/federal issued ID

License/IDNumber

ExpirationDate

(mm/dd/yyyy)Driver’s license or permitGovernment issuedID cardValid U.S. military

ID/common accesscardColoradoDepartment of Corrections inmateIDTribal ID card

U.S. passport

Certificate of Naturalization



FORM B con

Affidavit of Eligibility Page 2 of 2 Revised 5/2011

Section B: SECURE AND VERIFIABLE DOCUMENTS (continued)

Government IssuedIdentification

Name of state agencyor federal agency thatissued the document

Full name as shown on driver’slicense or state/federal issued ID

License/IDNumber

ExpirationDate

(mm/dd/yyyy)Certificate of (U.S.)CitizenshipValid TemporaryResident cardValid I-94 issued by

CanadiangovernmentValid I-94 withrefugee/asylumstamp

Valid I-766 (Employment Authorization Card) Issuing federal agency:

Name on card Alien Number (A#) Card Number Valid from

(mm/dd/yyyy)Expires

(mm/dd/yyyy)

Valid I-551 (Resident Alien or Permanent Resident Card) Issuing federal agency:

Name on card Alien Number (A#)Country of

birthCard expires(mm/dd/yyyy)

Resident since(mm/dd/yyyy)

Valid foreign passport with an unexpired visa with proper classification for work authorization, and an unexpired I-94

Issuing foreigncountry Passport Number Visa Number

Visa Class(ex.: J-1, P-1,

H-1B, etc.)Date of entry(mm/dd/yyyy)

Until date(mm/dd/yyyy)

Valid foreign passport bearing an unexpired “Processed for I-551” stamp or with an attached unexpired “Temporary I-551”visa

Issuing foreign country: Passport Number:

Section C: ATTESTATION

• I understand that this sworn statement is required by law because I have applied for or hold a professional or commercial license regulated by 8 U.S.C. sec. 1621. I understand that state law requires me to provide proof that Iam lawfully present in the United States when asked as well as submission of a secure and verifiable document. I mayalso be required to provide proof of lawful presence.

• I understand that in accordance with sections 18-8-503 and 18-8-501(2)(a)(I), C.R.S., false statements made hereinare punishable by law. I state under penalty of perjury in the second degree, as defined in 18-8-503, C.R.S. that theabove statements are true and correct.

• I am the person identified above and the information contained herein is true and correct to the best of my knowledge. Iunderstand that under Colorado law, providing false information is grounds for denial, suspension or revocation of alicense, certificate, registration or permit.

• I understand that the above information must be disclosed to the Department of Regulatory Agencies upon requestand is subject to verification.

Print Full Legal Name

Signature (Full Name) Date



In accordance with C.R.S. 18-8-503 and 18-8-501(2)(a)(I), false statements made herein are punishable by law. I state, under penalty of

perjury as defined in C.R.S. 18-8-503, that the information contained in this application, to the best of my knowledge, is true and correct. Iunderstand that under the Colorado Accountancy Law, providing false information to the Board is grounds for denial, suspension orrevocation of a CPA certificate.

DateSignature


Certificate of Experience

First Middle Last

Address

Employer:

Position of Applicant:

Address

City State Zip Code

Zip CodeStateCity

Telephone

Firm Registration Number:

PLEASE ONLY VERIFY EXPERIENCE WITHIN 5 YEARS PRECEDING THE DATE OF APPLICATION

Exact Dates of Employment: (mm/dd/yyyy) From: To: Full Time Part Time(If part time, refer to 4.1.F of the Rules.)

Please provide the number of qualifying work hours for each individual year for the time period stated above:

Have reviewed, agreed and signed the attached job description(s); and

Attest to having direct knowledge of work performed, as required by Colorado Rule 4.1.B, by the applicant during the entire datesof employment stated above. I performed periodic review and evaluation of the applicant's work, while holding an active statusCPA license to practice public accountancy during the entire period of employment being verified.

Attest the applicant, as required by Colorado Rule 4.1.B, has the work experience that involves the application of appropriatetechnical and behavioral standards, such as the standards contained in the AICPA Code of Professional Conduct, U.S. Generally

Accepted Accounting Principles (GAAP), U.S. Generally Accepted Auditing Standards (GAAS), Statements on Standards for Attestation Engagements (SSAE), Statements on Standards for Accounting and Review Services (SSARS), the Statements onStandards for Tax Services (SSTS), or the Statements on Standards for Management Consulting Services.

Attest the applicant has experience using the International Financial Reporting Standards (IFRS) in accordance with theInternational Accounting Standards Board (IASB).

Attest the applicant has experience using alternative standards; specify

Am unable to attest to the standards used.

FORM C

V e rifi e rS e c ti o n

A p p l i c a n t S e c t i o n

I, as a verifier,

Select one that applies.

Revised

Year 1 Year 2 Year 3 Year 4 Year 5 Total Hours



In your opinion, did the applicant obtain sufficient experience to satisfy the requirement below:

Qualifying public accounting experience shall consist of performing services for a client or potential client, including but not limited to anycombination of services involving the use of accounting or attestation skills, the issuance of reports on financial statements, management advisoryor consulting services, preparation of tax returns, or furnishing of advice on tax matters. Such work shall consist of employment by a CPA or Firmperforming services primarily involving the application of the standards described in Rule 4.1.B.


Qualifying industry experience shall consist of performing services, including for an employer, primarily involving the application of the standardsdescribed in Rule 4.1.B. Such services may include, but are not limited to, internal audit, installation of internal control systems, preparation of financial statements, management advisory or consulting services, preparation of tax returns, or the furnishing of advice on tax matters.

YES NO

Rule 4.2 - Experience in Public Accounting

Rule 4.3 - Experience in Industry

Rule 4.4 - Experience in Government

Rule 4.5 -Experience in Academia

YES NO

YES NO

YES NO


Qualifying academic experience consists of teaching in the accounting discipline for academic credit at a regionally accredited college or university.The teaching must include at least two different upper-division courses involving the standards described in Rule 4.1.B. One year of experienceshall consist of no less than 12 semester hours or the equivalent in quarter hours. Courses outside the field of accounting shall not count toward theexperience requirement. A letter from each institution where the qualifying hours were taught, signed by the dean or department head at thatinstitution must accompany this application. The letter must state: (a) the number of credit hours which the Applicant taught for the relevant years;

(b) the names and academic level of the courses taught; and (c) a course description. The Verifier shall be the department chair or a faculty memberwho also shall be a CPA.

FORM C co


Qualifying government experience shall consist of employment by a federal, state, or local government entity. Such work shall consist of employment performing services primarily involving the application of the standards described in Rule 4.1.B. Such services may include, but are notlimited to, internal or external audit, installation of internal control systems, preparation of financial statements, management advisory or consultingservices, preparation of tax returns, or the furnishing of advice on tax matters.

Revised 11

In accordance with sections 18-8-503 and 18-8-501(2)(a)(I), C.R.S., false statements made herein are punishable by law. I state, under penalty of perjury in the second degree, as defined in 18-8-503, C.R.S., that the information contained in this application, to the best of my knowledge, is trueand correct. I understand that under the Colorado Accountancy Law, providing false information to the Board is grounds for denial, suspension, orrevocation of a CPA certificate.

Date

Print Name

Signature

Position of Verifier

State of Licensure/License Number




Verifier's Licensure VerificationState Boards: NASBA Licensing Services, a division of the National Association of State Boards of Accountancy, and the certificate

processing agent for the Colorado State Board of Accountancy, requests that you verify the information presented below by answering allquestions. This form serves the purpose of verifying that the person and firm noted was certified/licensed by your jurisdiction during the

dates of employment listed. Upon completion of this form, return it to the applicant in a sealed envelope.Please do not send directly to NASBA Licensing Services . Return to applicant.

Dates of Employment with Firm/Company Named Below: to

Street

City State Zip Code Telephone

Verifying CPA's Name

Firm/Company Name

Did the verifying CPA named above hold an active certificate/license to practice public accountingduring the period of applicant's employment stated above?

YES NO Certificate/License Number

Did the firm/company named above hold an active certificate/license registration to practice as acertified public accounting firm during the period of employment stated above?

YES NO N/A

Please provide any further information you may have regarding the CPA/licensee/firm, including whether the CPA/licensee/firm has been subject to discipline.

I solemnly affirm, to the best of my knowledge, that the above information is true and correct.

(Board Seal) Official Signature /Board Representative

Title Date

FORM

(mm/dd/yyyy) (mm/dd/yyyy)

For Board Use

Applicant's Name

Revised 11




Transcript Request Form

Registrars: Please send a transcript in a sealed school envelope directly to the person listed in Section A of this form.

TelephoneZip CodeStateCity

Street

Other/MaidenLast NameMiddle NameFirst Name

Date of Birth Student ID # U.S. Social Security Number

College/University:

Street

City State Zip Code

Degree Dates of Attendance Date of Graduation

Fee Enclosed

Signature Date

Personal Information:

Section A

Section B

Revised 11



First Name Middle Name Last Name Maiden/Other Name

Street or P.O. Box

City State Zip Code Daytime Telephone

Date of Birth U.S. Social Security Number

Certificate Number (if applicable)

Signature Date

Yes No(If yes, please explain on following page.)

Date of Examination Candidate ID # Audit

LPR (Business Law)

FARE(Theory)

ARE(Practice)

150 Fourth Avenue NorthSuite 70

Nashville, TN 37219

Authorization for Interstate Exchangeof Examination and Licensure Information

State Boards: The applicant below has authorized you to provide any and all pertinent information listed in this formto NASBA Licensing Services, a division of the National Association of State Boards of Accountancy and an agent forthe Colorado State Board of Accountancy. Please return the form in a sealed envelope directly to the applicant.

Do not send to NASBA Licensing Services.

I hereby request and authorize the Board of Accountancy to provide anyand all pertinent information requested in this form to CPA Examination Services, as an agent for theColorado State Board of Accountancy. I agree that CPA Examination Services may confirm the gradesissued to me by the Advisory Grading Service of the American Institute of Certified Public Accountants.

1. Was the applicant ever denied admission to the Exam?

2. If the applicant has not completed the CPA Exam, arethere any restrictions preventing him/her from sitting in

your state?

3. If the applicant has not passed all parts of the CPA Exam,indicate above the expiration date of those parts that havebeen passed and for which credit has been given .

Yes No(If yes, please explain on following page.)

FORM E

For Board Use:

PA Exam Information

Revised 11



Board/Agency

Official Signature

Title

Date

1. The applicant was granted an original/reciprocal (circle one) CPA Certificate numberissued which is in good standing unless noted below.

2. The applicant has completed an Ethics Examination Yes No Score: The exam was prepared and graded by Board AICPA

License/Permit to Practice Public Accounting

3. This state is a two-tier state.4. The license/permit from this board is in good standing and expires5. The applicant is currently licensed to engage in the practice of public accounting.6. Has there ever been any disciplinary action instituted against the applicant?

(If yes, explain below.)

7. If the applicant does not hold a license/permit from your board, please indicate the requirements to be metfor issuance or reinstatement:

License/Permit not required:Pay appropriate fees/or post bond:Complete acceptable accounting/auditing experience:Complete continuing professional education requirements:Other:

Yes No Yes No Yes No Yes No

Additional Information:

Exceptions noted/explanations:

Board Seal

License Information



If you are applying for licensure with examination scores obtained more than 10 years prior tothe application receipt date, you shall:

A. Obtain and supply proof of completing 80 hours of CPE taken within two years of theapplication receipt date. (CPE Worksheet attached) No education in Personal Development,as defined by the Fields of Study, may be counted toward the 80 hours. In addition you mustcomplete and pass the AICPA Ethics Examination and obtain two hours of CR&R;

OR

B. Supply the Board with proof of three years of experience as defined in Chapter 4 of theColorado Rules and Regulations within the five years of application receipt date. Verificationof experience should be submitted on Form C - Certificate of Experience.

FORM

Rule 3.9



Report only hours that have been taken within two(2) years preceding the date of application.

Course Title Course Date Course Provider CE Hours Earned

CPE CHART

TOTAL CPE HOURS REPORTED:I certify under penalty of perjury to the truth and accuracy of all statements, answers, and representations made inthis report of continuing professional education.

Signature Date



Credit Card Payment Form

Applicant Name:

Fees are non-refundable and non-transferable

Authorized Payment Amount: Application fee for Initial Applications by Exam ($110) Application fee for Initial Applications by Transfer of Grades ($185)

Please Check One: Visa MasterCard

Card Number:

Expiration Date:

Print Name as it appears on account:

Authorized Signature:

Return this payment form with Application Package.

Note: This document will be shredded after it has been processed

Revised 11



IMPORTANT NOTICETO : All Applicants

FROM : Rosemary McCool, Director, Division of Registrations

SUBJECT : Licensure and Criminal History

Thank you for your interest in becoming a licensed* professional within the Division of Registrations.Before you submit your application, please be aware of a few facts regarding criminal conduct,convictions, and disciplinary actions in other states.

The mission of the Division of Registrations is “public protection through effective licensure andenforcement.” One way the Division safeguards consumers is by issuing licenses to fully qualified,competent, and ethical applicants.

During the licensing process – and depending on the specific application – the Division will ask whether you have ever been disciplined in any state, arrested, charged, convicted, or pled guilty to a crime. Anarrest, subsequent criminal conviction, or disciplinary action is not an automatic disqualification fromlicensure. Instead, the appropriate board or program will look at the facts surrounding the criminalconduct and disciplinary action to determine whether you are fit for licensure. You should know thatlicensure is a privilege, not a right. One thing you must do to obtain the privilege is to be completelyhonest on your application.

Be sure to list all relevant complaints, disciplinary actions, arrests, charges, or convictions in responseto the licensure questions. Failure to fully disclose could constitute grounds alone for denial of your application or revocation of your license. More important, avoid some of the common excuses we haveheard from people who failed to disclose, such as:

• My attorney told me I didn’t have to disclose the criminal conduct or disciplinary actions.

• I didn’t think the prior conduct had anything to do with the profession.

• I didn’t think the disciplinary action, arrest, charges, or conviction was still on my record.

• I didn’t think it was subject to disclosure because I received a deferred sentence/judgment.

Remember, there is no excuse not to disclose disciplinary actions and criminal conduct. Even after licensure, you are still required to notify your professional licensing board or program about subsequentconvictions and disciplinary actions in other states.

The Division conducts audits of its licensing database against several criminal and national disciplinary

databases. This allows the Division to verify the truthfulness of your application and track subsequentcriminal and disciplinary conduct after initial licensure. Keep in mind, you will not necessarily berevoked or denied a license if you have been disciplined, arrested, charged or convicted, but you willmost likely be denied or revoked if you fail to disclose it.

*The word "license" is used as a general term. While most of the professions and occupations are licensed, others may be registered,certified, or listed. For precise terminology and requirements related to a profession or occupation, please consult the website of theappropriate board or program.

1560 Broadway, Suite 1350 Denver, Colorado 80202 Phone 303.894.7800Fax 303.894.7693 www.dora.state.co.us V/TDD 711

CO Initial App June2011

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